Is it better to cut down before stopping?

Author and presenter:
Nicola Lindson
PhD Researcher, Primary Care Clinical Sciences, University of Birmingham, UK

Abstract
Conventional wisdom suggests that stopping smoking abruptly is the best way to quit. However many smokers would like to reduce their intake before quitting. Providing this service could encourage more
people into treatment, but before this is offered it is important to ensure it is at least as successful as abrupt quitting. We conducted a Cochrane review to compare the success rates of reduction to quit and abrupt quitting interventions. We searched the Cochrane Tobacco Addiction Review Group specialised register, MEDLINE, EMBASE and PsycInfo for randomized controlled trials (RCTs) that recruited adults who wanted to quit smoking. Studies included at least one condition, which instructed
participants to reduce their smoking and then quit, and one condition which instructed participants to quit abruptly. A meta-analysis was conducted to compare quit rates between groups, using the Mantel-
Haenszel fixed-effect model for pooling results and relative risk as the summary statistic. Ten studies were found that met inclusion criteria. Neither reduction to quit nor abrupt quitting produced superior abstinence rates (RR = 0.94, 95% CI = 0.79 – 1.13). This effect was observed whether pharmacotherapy was used or not, and whether the intervention provided included behavioural support or self-help therapy.

We conclude that reducing smoking before quit day produces comparable quit rates to quitting abruptly, therefore smokers could be given the option to quit either way, particularly if they have failed to quit abruptly in the past. Further research is needed to investigate which reduction method is the most successful, to inform future policy and intervention development.

Source of funding: Nicola’s PhD is funded by the Economic and Social Research Council (ESRC) through the UK Centre for Tobacco Control Studies. The UK Cochrane Centre is funded by the National Health Service Research and Development Programme.

Declaration of Interest: none

About the presenter

Nicola Lindson is a PhD student in Primary Care Clinical Sciences at the University of Birmingham, and is part of the UK Centre for Tobacco Control Studies. Her PhD research is focused on smoking reduction, including comparing abrupt quitting with reduction to quit, investigating reduction methods and their relative success, and interviewing trial participants about their experiences of different quitting methods.